Peeters P H, Verbeek A L, Hendriks J H, Holland R, Mravunac M, Vooijs G P
Department of Social Medicine, Nijmegen University, The Netherlands.
Br J Cancer. 1989 Jun;59(6):929-32. doi: 10.1038/bjc.1989.196.
Since January 1975 a population-based screening programme for the early detection of breast cancer has been carried out in the city of Nijmegen. During five interscreening periods of 2 years each a total of 158 so-called interval cancers were diagnosed. Careful revision of all screening and diagnostic mammograms was executed. Of all interval cancers 26% were 'missed' at the previous screening examination (due to technical or observer error), 16% were radiographically occult at the time of diagnosis and 58% were 'true' interval cancers. Interval cancers were regarded as 'true' when an obvious lesion was observed on the diagnostic mammogram while no suspect signs were seen on the previous screening mammogram. The prevalence of 'missed' cancers did not decline in the course of the screening programme. Radiographically occult tumours were localised, mostly in Wolfe's P2/DY breast parenchyma (83%), 33% were lobular invasive and 25% ductal non-invasive. 'True' interval cancer cases (58%) showed the same overall survival as control breast cancer patients, diagnosed in a non-screening situation. Shortening the screening interval would reduce interval cancer rates and probably further decrease breast cancer mortality in a screened population. However, from the present series of interval cancers 63% would not have been prevented by an annual screening examination. As regards women under age 50 annual screening would still leave 66% of all interval cancers in this age group undetected. Probably more benefit will be gained by searching for new imaging techniques to reduce numbers of 'missed' cancers and to detect lobular invasive and ductal non-invasive cancers in dense breast parenchyma.
自1975年1月起，奈梅亨市开展了一项基于人群的乳腺癌早期检测筛查项目。在每两年的五个筛查间期内，共诊断出158例所谓的间期癌。对所有筛查和诊断性乳房X光片进行了仔细复查。在所有间期癌中，26%在之前的筛查检查中“漏诊”（由于技术或观察者失误），16%在诊断时乳房X光片上未显示异常，58%为“真正的”间期癌。当诊断性乳房X光片上观察到明显病变而之前的筛查乳房X光片上未发现可疑迹象时，间期癌被视为“真正的”。在筛查项目过程中，“漏诊”癌的患病率并未下降。乳房X光片上未显示异常的肿瘤大多位于沃尔夫P2/DY型乳腺实质（83%），33%为小叶浸润性癌，25%为导管非浸润性癌。“真正的”间期癌病例（58%）与在非筛查情况下诊断出的对照乳腺癌患者的总生存率相同。缩短筛查间期将降低间期癌发病率，并可能进一步降低筛查人群中的乳腺癌死亡率。然而，从目前的间期癌系列来看，每年进行一次筛查检查无法预防63%的间期癌。对于50岁以下的女性，每年进行筛查仍会漏诊该年龄组所有间期癌的66%。通过寻找新的成像技术以减少“漏诊”癌数量，并在致密乳腺实质中检测小叶浸润性癌和导管非浸润性癌，可能会获得更多益处。
